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Circulation. 1998;97:282-289

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*Heart Failure

(Circulation. 1998;97:282-289.)
© 1998 American Heart Association, Inc.

Current Perspective

Chronic Heart Failure in the United States

A Manifestation of Coronary Artery Disease

Mihai Gheorghiade, MD; ; Robert O. Bonow, MD

From the Division of Cardiology, Northwestern University Medical School, Chicago, Ill.

Correspondence to Robert O. Bonow, MD, Division of Cardiology, Northwestern University Medical School, 250 E Superior, Wesley 524, Chicago, IL 60611.


Key Words: coronary disease • endothelium • heart failure • ischemia

Despite significant progress in the prevention and treatment of cardiovascular disease in the United States in the past two decades,1 national statistics indicate that the incidence and prevalence of chronic heart failure have been increasing steadily in recent years,2 especially in the elderly.3 It is estimated that {approx}4 to {approx}5 million individuals living in the United States have chronic heart failure, with 400 000 new cases occurring each year.4 5 6 Chronic heart failure results in almost 1 million hospitalizations each year7 and is the most common hospital discharge diagnosis in patients above the age of 65 years.8 The evaluation and care of patients with heart failure, not taking into account lost wages and productivity, cost our society in excess of $11 billion each year.7 8 9

In the past two decades, considerable attention has been placed on left ventricular (LV) dysfunction, loading conditions, and neuroendocrine activation as pathophysiological mechanisms for progression of heart failure,10 11 and pharmacological therapy has been targeted against these mechanisms.12 13 14 However, the fundamental shift in the etiology of heart failure often is underemphasized. The most common cause of chronic heart failure is no longer hypertension or valvular heart disease, as it was in past decades, but rather coronary artery disease (CAD).15 In 13 multicenter heart failure treatment trials reported in the New England Journal of Medicine over the past 10 years,16 17 18 19 20 21 22 23 24 25 26 27 28 involving >20 000 patients, CAD was the underlying etiology of heart failure in nearly 70% of the patients (Fig 1Down). This probably is an underestimation of the true . . . [Full Text of this Article]




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M. F. Berry, T. J. Pirolli, V. Jayasankar, J. Burdick, K. J. Morine, T. J. Gardner, and Y. J. Woo
Apelin Has In Vivo Inotropic Effects on Normal and Failing Hearts
Circulation, September 14, 2004; 110(11_suppl_1): II-187 - II-193.
[Abstract] [Full Text] [PDF]

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J J Bax, E E van der Wall, and M Harbinson
Radionuclide techniques for the assessment of myocardial viability and hibernation
Heart, August 1, 2004; 90(suppl_5): v26 - v33.
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V. L. Roger, S. A. Weston, M. M. Redfield, J. P. Hellermann-Homan, J. Killian, B. P. Yawn, and S. J. Jacobsen
Trends in Heart Failure Incidence and Survival in a Community-Based Population
JAMA, July 21, 2004; 292(3): 344 - 350.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
S. Schenk, P. M. McCarthy, R. C. Starling, K. J. Hoercher, M. D. Hail, Y. Ootaki, G. S. Francis, K. Doi, J. B. Young, and K. Fukamachi
Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy
J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 38 - 43.
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Y.-M. Cha, M. M. Redfield, W.-K. Shen, and B. J. Gersh
Atrial Fibrillation and Ventricular Dysfunction: A Vicious Electromechanical Cycle
Circulation, June 15, 2004; 109(23): 2839 - 2843.
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 Eur J Heart FailHome page
F. Pedersen, I. Raymond, L. H. Madsen, J. Mehlsen, D. Atar, and P. Hildebrandt
Echocardiographic indices of left ventricular diastolic dysfunction in 647 individuals with preserved left ventricular systolic function
Eur J Heart Fail, June 1, 2004; 6(4): 439 - 447.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Huang, S. N. Hunyor, L. Jiang, O. Kawaguchi, K. Shirota, Y. Ikeda, T. Yuasa, G. Gallagher, B. Zeng, and X. Zheng
Remodeling of the chronic severely failing ischemic sheep heart after coronary microembolization: functional, energetic, structural, and cellular responses
Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2141 - H2150.
[Abstract] [Full Text] [PDF]

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 Circ. Res.Home page
T. E. Lindley, M. F. Doobay, R. V. Sharma, and R. L. Davisson
Superoxide Is Involved in the Central Nervous System Activation and Sympathoexcitation of Myocardial Infarction-Induced Heart Failure
Circ. Res., February 20, 2004; 94(3): 402 - 409.
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E. van Rooij, P. A. Doevendans, H. J.G.M. Crijns, S. Heeneman, D. J. Lips, M. van Bilsen, R. S. Williams, E. N. Olson, R. Bassel-Duby, B. A. Rothermel, et al.
MCIP1 Overexpression Suppresses Left Ventricular Remodeling and Sustains Cardiac Function After Myocardial Infarction
Circ. Res., February 20, 2004; 94 (3): e18 - e26.
[Abstract] [Full Text] [PDF]

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P. G. Steg, O. H. Dabbous, L. J. Feldman, A. Cohen-Solal, M.-C. Aumont, J. Lopez-Sendon, A. Budaj, R. J. Goldberg, W. Klein, F. A. Anderson Jr, et al.
Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes: Observations From the Global Registry of Acute Coronary Events (GRACE)
Circulation, February 3, 2004; 109(4): 494 - 499.
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A. F. L. Schinkel, D. Poldermans, V. Rizzello, J.-L. J. Vanoverschelde, A. Elhendy, E. Boersma, J. R.T.C. Roelandt, and J. J. Bax
Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization?
J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 385 - 390.
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I Raymond, F Pedersen, F Steensgaard-Hansen, A Green, M Busch-Sorensen, C Tuxen, J Appel, J Jacobsen, D Atar, and P Hildebrandt
Prevalence of impaired left ventricular systolic function and heart failure in a middle aged and elderly urban population segment of Copenhagen
Heart, December 1, 2003; 89(12): 1422 - 1429.
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 Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
H. R. De Smet, M. F. Menadue, J. R. Oliver, and P. A. Phillips
Increased thirst and vasopressin secretion after myocardial infarction in rats
Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2003; 285(5): R1203 - R1211.
[Abstract] [Full Text] [PDF]

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 Am. J. Pathol.Home page
S. Gattenlohner, C. Waller, G. Ertl, B.-D. Bultmann, H.-K. Muller-Hermelink, and A. Marx
NCAM(CD56) and RUNX1(AML1) Are Up-Regulated in Human Ischemic Cardiomyopathy and a Rat Model of Chronic Cardiac Ischemia
Am. J. Pathol., September 1, 2003; 163(3): 1081 - 1090.
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 Am J EpidemiolHome page
J. P. Hellermann, T. Y. Goraya, S. J. Jacobsen, S. A. Weston, G. S. Reeder, B. J. Gersh, M. M. Redfield, R. J. Rodeheffer, B. P. Yawn, and V. L. Roger
Incidence of Heart Failure after Myocardial Infarction: Is It Changing over Time?
Am. J. Epidemiol., June 15, 2003; 157(12): 1101 - 1107.
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M. Gheorghiade, W. S. Colucci, and K. Swedberg
{beta}-Blockers in Chronic Heart Failure
Circulation, April 1, 2003; 107(12): 1570 - 1575.
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G. M. Felker, R. L. Benza, A. B. Chandler, J. D. Leimberger, M. S. Cuffe, R. M. Califf, M. Gheorghiade, C. M. O'Connor, and OPTIME-CHF Investigators
Heart failure etiology and response tomilrinone in decompensated heart failure: Results from the OPTIME-CHF study
J. Am. Coll. Cardiol., March 19, 2003; 41(6): 997 - 1003.
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P.O Bonetti, L.O Lerman, C Napoli, and A Lerman
Statin effects beyond lipid lowering--are they clinically relevant?
Eur. Heart J., February 1, 2003; 24(3): 225 - 248.
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B. L.R. Kam, R. Valkema, D. Poldermans, J. J. Bax, A. E.M. Reijs, R. Rambaldi, E. Boersma, T. Rietveld, J. R.T.C. Roelandt, and E. P. Krenning
Feasibility and Image Quality of Dual-Isotope SPECT Using 18F-FDG and 99mTc-Tetrofosmin After Acipimox Administration
J. Nucl. Med., February 1, 2003; 44(2): 140 - 145.
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 Am. J. Physiol. Heart Circ. Physiol.Home page
B. M. Jackson, J. H. Gorman III, I. S. Salgo, S. L. Moainie, T. Plappert, M. St. John-Sutton, L. H. Edmunds Jr., and R. C. Gorman
Border zone geometry increases wall stress after myocardial infarction: contrast echocardiographic assessment
Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H475 - H479.
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A. M. Duncan, D. P. Francis, M. Y. Henein, and D. G. Gibson
Limitation of cardiac output by total isovolumic time during pharmacologic stress in patients with dilated cardiomyopathy: Activation-mediated effects of leftbundle branch block and coronary artery disease
J. Am. Coll. Cardiol., January 1, 2003; 41(1): 121 - 128.
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 Physiol. Rev.Home page
D. L. Brutsaert
Cardiac Endothelial-Myocardial Signaling: Its Role in Cardiac Growth, Contractile Performance, and Rhythmicity
Physiol Rev, January 1, 2003; 83(1): 59 - 115.
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 Ann. Thorac. Surg.Home page
S. L. Moainie, J. H. Gorman III, T. S. Guy, F. W. Bowen III, B. M. Jackson, T. Plappert, N. Narula, M. G. St. John-Sutton, J. Narula, L. H. Edmunds Jr, et al.
An ovine model of postinfarction dilated cardiomyopathy
Ann. Thorac. Surg., September 1, 2002; 74(3): 753 - 760.
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K Kjeldsen, A Norgaard, and M Gheorghiade
Myocardial Na,K-ATPase: the molecular basis for the hemodynamic effect of digoxin therapy in congestive heart failure
Cardiovasc Res, September 1, 2002; 55(4): 710 - 713.
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 Ann. Thorac. Surg.Home page
S. L. Moainie, T. S. Guy, J. H. Gorman III, T. Plappert, B. M. Jackson, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman
Infarct restraint attenuates remodeling and reduces chronic ischemic mitral regurgitation after postero-lateral infarction
Ann. Thorac. Surg., August 1, 2002; 74(2): 444 - 449.
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A F L Schinkel, J J Bax, F B Sozzi, E Boersma, R Valkema, A Elhendy, J R T C Roelandt, and D Poldermans
Prevalence of myocardial viability assessed by single photon emission computed tomography in patients with chronic ischaemic left ventricular dysfunction
Heart, August 1, 2002; 88(2): 125 - 130.
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M. Gheorghiade and S. Goldstein
{beta}-Blockers in the Post-Myocardial Infarction Patient
Circulation, July 23, 2002; 106(4): 394 - 398.
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A. Tenenbaum, E. Z. Fisman, and M. Motro
Toward a redefinition of ischemic cardiomyopathy: is it an indivisible entity?
J. Am. Coll. Cardiol., July 3, 2002; 40(1): 205 - 206.
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J. J. Bax, J. Maddahi, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, J. R.T.C. Roelandt, and P. M. Fioretti
Sequential 201Tl Imaging and Dobutamine Echocardiography to Enhance Accuracy of Predicting Improved Left Ventricular Ejection Fraction After Revascularization
J. Nucl. Med., June 1, 2002; 43(6): 795 - 802.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
R. O. Bonow, W. E. Mitch, R. W. Nesto, P. T. O'Gara, R. C. Becker, L. T. Clark, S. Hunt, I. Jialal, S. E. Lipshultz, and E. Loh
Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group V: Management of Cardiovascular-Renal Complications
Circulation, May 7, 2002; 105 (18): e159 - e164.
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 J Am Coll CardiolHome page
R. O. Bonow
Myocardial viability and prognosis in patients with ischemic left ventricular dysfunction
J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1159 - 1162.
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M. S. Cuffe, R. M. Califf, K. F. Adams Jr, R. Benza, R. Bourge, W. S. Colucci, B. M. Massie, C. M. O'Connor, I. Pina, R. Quigg, et al.
Short-term Intravenous Milrinone for Acute Exacerbation of Chronic Heart Failure: A Randomized Controlled Trial
JAMA, March 27, 2002; 287(12): 1541 - 1547.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
K. E. Gould, G. E. Taffet, L. H. Michael, R. M. Christie, D. L. Konkol, J. S. Pocius, J. P. Zachariah, D. F. Chaupin, S. L. Daniel, G. E. Sandusky Jr., et al.
Heart failure and greater infarct expansion in middle-aged mice: a relevant model for postinfarction failure
Am J Physiol Heart Circ Physiol, February 1, 2002; 282(2): H615 - H621.
[Abstract] [Full Text] [PDF]


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